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目的:探讨99mTc-MDP骨三相扫描在骨肉瘤病人中的显像特点和应用价值。方法:回顾了我院2006年4月-2007年1月经穿刺活检及手术病理诊断为骨肉瘤的24例患者,男12例,女12例,最小年龄11岁,最大50岁,平均年龄20.6岁,所有患者都使用GE公司的Hawkeye SPECT进行99mTc-MDP骨三相扫描,图像经Entegra工作站处理。在血流灌注相,利用感应区技术(ROI),就肿瘤血流灌注开始时间、最高计数率、计数率达高峰时间、快速灌注持续时间、计数率-时间曲线斜率、曲线下面积与健侧进行比较,行两样本均数比较t检验。并计算计数率-时间曲线斜率比值、曲线下面积比值。另外计算血池相计数与对侧比值、延迟相计数与对侧比值(T/NT)及两样本均数比较配对t检验。观察结果延迟相的显像特点。结果:58.3%发生在股骨的(14/24),其中股骨下9例;37.5%发生在胫骨(9/24),其中胫骨上7例;发生在腓骨仅1例;累及2块骨头以上为5例。未发现远处部位转移。肿瘤血流灌注平均开始时间、计数率达高峰时间、快速灌注持续时间、最高计数率、计数率-时间曲线斜率、曲线下面积分别为(3.04±1.94)s,(13.43±3.98)s,(10.52±3.06)s,(958.26±469.24)counts/s,99.15±61.02,(49797±25157.24)counts,健侧分别为(4.70±3.25)s,(18.26±5.69)s,(13.57±4.57)s,(270±160.51)counts/s,23.22±19.20,(13403±8821.95)counts,两者相比均有统计学意义(P(0.05),两者斜率比值为6.03±4.68,曲线下面积比值为4.99±3.62。血池相计数与对侧比值、延迟相计数与对侧比值分别为3.34±1.53,6.02±3.12,两者相比具有统计学意义(P(0.05)。延迟显像,放射性异常高度浓聚,核素分布均匀41.7%,不均匀者58.3%,病变内出现放射性稀疏、缺损者占54.2%,另外软组织可见侵犯并有不均匀放射性浓聚。结论:99mTc-MDP骨三相扫描为骨肉瘤的诊断提供了丰富的信息,具有较高的临床价值。
Objective: To investigate the imaging features and application value of 99mTc-MDP bone three-phase scanning in patients with osteosarcoma. Methods: A retrospective study of 24 patients with osteosarcoma diagnosed by biopsy and surgical pathology from April 2006 to January 2007 in our hospital, including 12 males and 12 females, with a minimum age of 11 years and a maximum of 50 years with a mean age of 20.6 years All patients underwent 99mTc-MDP bone-phase scanning using GE’s Hawkeye SPECT and the images were processed using an Entegra workstation. In the perfusion phase, the area of tumor perfusion, the highest count rate, the peak count rate, the fast perfusion duration, the slope of the count rate-time curve, the area under the curve and the contralateral area For comparison, the two samples were compared t-test. And calculate the count rate - the slope of the time curve ratio, area ratio under the curve. In addition, the blood pool phase and contralateral ratio, delayed phase count and contralateral ratio (T / NT) and paired t-test were calculated. Observation of delayed phase imaging features. Results: 58.3% occurred in the femur (14/24), including 9 in the femur, 37.5% in the tibia (9/24), 7 in the tibia, 1 in the fibula, 2 in 2 5 cases. No distant metastasis was found. The mean onset time of tumor perfusion, peak count rate, duration of rapid perfusion, maximum count rate, slope of count rate-time curve and area under the curve were (3.04 ± 1.94) s and (13.43 ± 3.98) s respectively (4.70 ± 3.25) s, (18.26 ± 5.69) s and (13.57 ± 4.57) s, respectively. The mean ± SD was 10.52 ± 3.06 s, 958.26 ± 469.24 counts / s, 99.15 ± 61.02 and 49797 ± 25157.24 counts, respectively , (270 ± 160.51) counts / s, 23.22 ± 19.20 and (13403 ± 8821.95) counts, respectively (P (0.05)), the slope ratio was 6.03 ± 4.68. The area under the curve was 4.99 ± 3.62, respectively.The blood pool phase count and contralateral ratio, delayed phase count and contralateral ratio were 3.34 ± 1.53 and 6.02 ± 3.12, respectively, with statistical significance (P <0.05) .Delay imaging and radiological abnormalities Highly concentrated, the distribution of radionuclides was 41.7% and 58.3% respectively. There was sparse radioactivity in the lesion, which accounted for 54.2% of the total defects. In addition, the soft tissue showed invasion and uneven radioactive concentration.Conclusion: 99mTc-MDP For the diagnosis of osteosarcoma provides a wealth of information, with high clinical value.